Heel Pain – The truth behind the Morning Misery

Over the last 20 years career, there have been major medical advancements in foot and ankle surgery. But in one arena, few things have changed.

When my heel pain patients come to the office, they are not only frustrated, but those painful first few steps in the morning have them or their spouses putting everything aside in their lives to make an appointment. Then sometimes cancelling….

Why? Because sometimes it goes away.

Why? Because in reality, it is an injury.

Plantar fasciitis is simply the band or the simile we us “bow string” like structure connecting the ball of your foot to the bottom of your heel (calcaneus bone).

So who cares, get to the point and where is my pill to make this all go away? Because 75% of our patients are cured and avoid surgery with a little education.

The foot is a simple machine made up of 26 bones that essentially ‘lock and unlock’ when standing and walking. This unlocking and dropping of the archway puts stress on the plantar fascia, unfortunately and must commonly where it connects to the bottom of the heel. The “heel spur” in reality is a calcification where the ligament attaches, not something that grows out of the heel and is responsible for that sharp pain in the morning. Its the pulling or micro ‘tears’ on the bottom of the heel combined with your entire body weight that causes the pain.

Then there is the other enigma. “After a few steps in the morning, it warms up and goes away” Not to get too scientific or deep into neurology, but the theory is that this is a evolutionary response to survive, cover up the pain and keep moving – or in the past, to get away from predators when injured. Repetitive pressure to the area can interrupt the pain signal to the brain temporarily. But with a short rest or sleeping all night, the distraction is gone and that first step sends that lovely, uninterrupted pain signal telling its homo sapien host – “me still injured”.

It’s a confusing paradigm because for most patients who have the mild to moderate variety (not seriously torn or a stress fracture) feel if they keep moving, they have less pain. But in reality, they are continuing to injure themselves by simply going to work or going out to get the mail.

We still give a mild cortisone injection that gives relief and has no side effects, but the main emphasis for this problem is to rest and hold the arch up when the essential weight bearing (like getting something to eat) is necessary. But rest is still the top priority. In professional sports, some players are using crutches to speed up recovery and healing time.

The good news for the rest of us is that enduring the pain and getting in to a better shoe with a higher heel (more weight on the ball of foot) or higher arch with ‘heel stabilizer’ like a running shoe can do the trick.

Arch supports can help as well, but for long term relief, orthotics are the holy grail. The problem is that not all orthotics are created equal, especially the custom molded variety. I have modified a traditional molding technique and better orthotic material that essentially cures 75% of my patients. Polypropylene is a thermo-molded, thin material that is also flexible to withstand activities like jogging or even high impact sports. Although we have several athletes using our device in their cleats and high top shoes, our female patients benefit the most since they can use these custom molded orthotics in their flats due their slim design.

Of course there is a surgery available for the remaining 25% of the patients who do not heal or have continued pain, but it’s becoming more and more rare. The procedure is quick with a small incision, sutures removed 2 weeks, full weight bearing in 3 weeks.